April 9, 2021

Example of how lessons learned can be summarized


Thanks for joining today, sorry, my non-Duke zoom plan ended after 40 min.

I hope today was valuable.  Appreciate all of you taking the time to review your cases.  Nice job!!

Here are some of the items I learned from all of you:

1) It’s important to read not only the summary from radiology but also the details of the procedure and all of the findings that are written in the body of the note.

2) Adrenal nodules need careful management and should include a full endocrine workup at baseline, and also pts should have yearly  Dex Suppression Tests. ( 1 mg Dexamethasone should be given at 11-12 pm and the next day, serum cortisol should be drawn at 8 am).

3) We need to read through the nursing notes from the engagement center and make sure we are in agreement with their proposed plans.  ( I will communicate with Amanda to look at the individual case that was possibly miss triaged to Vaidehi to see by video visit for 5 weeks of nausea and vomiting and abdominal pain.)

4) We were reminded of the challenges of trying to care for and evaluate individuals with passive suicidal ideation, and we reviewed the risk factors for suicide.  Fatima shared some of her frustrations with trying to provide

the care that her depressed, lonely, isolated individual needed.

5) We need to be vigilant when patient’s care is turned back to us from specialists, and it would be wonderful if a

“handoff” occurred somehow so we might know how to care for and manage our patients.  Special attention should be focused seemingly on cases coming from endocrine and endocrine surgery.

6) There are troubles getting timely results back from cardiology when patients have Holter monitors placed.


I know there were more take-home points, feel free to chime in if desired.

I will separately send a document explaining how to close your peer review document.  It is really not too bad.

It is something to do sooner rather than later, otherwise, Sharon says we will get daily emails bugging us to close the cases.

Let me know your thoughts about how to make this more educational and valuable.  I think going forward, I won’t try to have everyone discuss their case, and will focus on maybe 4-5 cases so we can have more discussion.

Have a great day.